Chapter 19

  • National Patient Safety Goals (NPSGs)

    • Established by The Joint Commission (TJC) to improve patient safety and an ongoing focus within healthcare.

    • Updated regularly to reflect current challenges and recommendations from experts.

    • Key goals include:

      • Identify patients correctly (using at least two identifiers, e.g., name and date of birth).

      • Improve staff communication (communicating critical test results promptly).

      • Ensure safe medication use (ensure accurate medication history).

      • Improve alarm safety (ensure alarms are heard and responded to).

      • Prevent infection (follow hand-hygiene guidelines).

      • Identify patient safety risks (risk assessments, including suicide risks).

      • Prevent mistakes in surgery (label surgical sites and verify procedure).

  • Developmental Stage Injuries

    • Infants: Vulnerable to falling from changing tables.

    • Toddlers: At risk for accidental poisoning and drowning due to curiosity and mobility.

    • School-aged Children: Prone to play-related injuries and sports injuries due to increased physical activity.

    • Adolescents: High-risk behaviors lead to injuries (lack of protective gear).

    • Adults: Risks from neglecting safety measures (texting while driving, seat belt usage).

    • Older Adults: Increased fall risk due to impaired mobility, medications, and environmental hazards.

  • Environmental Hazards

    • Common hazards include latex sensitization, electrical shock, thermal burns, and poisoning.

    • Latex Sensitization: Individuals may develop allergies due to repeated exposure. Measures include using alternative gloves and creating latex-safe environments.

    • Burn Prevention: Awareness of common causes of burns in healthcare settings, emphasizing the need for safety systems (e.g., smoke detectors).

    • Fire Management: Familiarity with fire plans is critical; basic steps include RACE (Rescue, Alarm, Confine, Extinguish).

  • Asphyxiation Risks

    • Principal causes include smoke inhalation and carbon monoxide poisoning.

    • Smoke Inhalation: More deadly than flames; symptoms include coughing and unconsciousness.

    • Carbon Monoxide: Preventable with detectors; exposure leads to symptoms including dizziness and nausea.

  • Drowning Prevention

    • Prevention strategies include swimming lessons, supervision, and maintaining pool safety. Nurses should never leave vulnerable clients alone in water.

  • Electrical Shock

    • Risks are prevalent due to the body’s conductivity. Prevention includes using grounded equipment and avoiding wet hands when handling electrical devices.

  • Poisoning

    • Common household poisoning products include cleaning agents and medications.

    • Prevention involves education, secure storage, and poison control center awareness.

  • Fall Prevention in Older Adults

    • Contributing factors: impaired vision, medication side-effects, and environmental factors (clutter, poor footwear).

    • Assessment tools like the Hendrich II Fall Risk Model aid in identifying at-risk individuals.

    • Preventative measures include ensuring bright lighting, installing handrails, and using assistive devices (cane/walker).

  • Restraints

    • Defined as physical or chemical methods to limit movement. Strictly regulated; should only be last resorts after less restrictive alternatives are exhausted.

    • Regulations follow the Omnibus Budget Reconciliation Act (OBRA) guidelines, which protect resident rights.

    • Alternatives may include adaptive devices that allow freedom of movement while ensuring safety.

  • Key Nursing Implications

    • Nurses must identify safety hazards and assess clients for injury risk. Monitoring and frequent evaluations are essential to prevent accidents.